The science and art of hyaluronic acid dermal filler use in esthetic applications michael gold md department of dermatology, vanderbilt university school of medicine, nashville, tn, usa. Hyaluronic acid is a chemical compound which has revolutionised aesthetic medicine. Biodegradable agents can be divided into two categories. Hyaluronica is a range of injectable fillers based on reticulated hyaluronic acid of nonanimal origin, which aim to maintain hydration in the skin tissues and also to keep skin smooth and soft, diminish visible wrinkles, restore skins volume and moderate overall face area or a specific feature. At physiologic ph, ha has excellent biocompatibility as it is anionic and thus binds towater extensively where 1 g ha can bind up to 6 l water.
Serious complications due to vascular occlusion include cutaneous necrosis and blindness, which although rare can occur due to the compression of the vessel or direct intravascular injection. Comparative physical properties of hyaluronic acid dermal fillers jeffrey kablik, gary d. The chemical composition of disaccharide ha monomers, and how they form polymer chains and are crosslinked into gels for dermal fillers are described. In this study, we used an hapn hyaluronic acidpolynucleotide. Hyaluronic acid derivatives ha is a naturally occurring glycosaminoglycans composed of dglucuronic acid and nacetyldglucosamine found in the dermis. Ha fillers appear to besimilar, but their physical. First attempts at soft tissue augmentation were made early in the last century with more or less inappropriate material, such as wax, but became more effective and frequent due to the invention of silicone oil by eugene g. But the two have some different uses, costs, and efficacies. Ha fillers appear to be similar, but their physical characteristics can be quite different. Comparative evaluation of the effectiveness of novel. Hyaluronic acid dermal fillers add volume to the face and usually look completely natural.
The evolving role of hyaluronic acid fillers for facial. Ha hyaluronic acid filler, the most commonly used dermal filler, causes several side effects. Hyaluronic acid ha hyaluronic acid is a naturally occurring substance that is already found in your skin. Comparative physical properties of hyaluronic acid dermal fillers. Residents or practitioners new to aesthetics and experienced providers alike can benefit from this series which. Both restylane and radiesse are dermal fillers that are designed to add volume to the skin. The cosmetic industry has long used the hydrophilic and nonimmunogenic properties of ha for the development of cosmetic dermal fillers with no adverse side effects. A comparison of the efficacy, safety, and longevity of two different hyaluronic acid dermal fillers in the treatment of severe nasolabial folds. With the increasing number of available ha fillers and the multiplication of facial treatments all over the world, there has been a need from physicians to better understand the ha fillers science. Comparative physical properties of hyaluronic acid dermal. Key concepts and properties relevant to the production and performance of ha dermal fillers, such as the degree of crosslinking, gel hardness, gel. The science of hyaluronic acid dermal filler skinviva. The science and art of hyaluronic acid dermal filler use in esthetic.
Fillers are prepared from diverse materials including autologous implants, collagens, hyaluronic acid ha, and biosynthetic polymers, and are marketed for cosmetic purposes 1. Hyaluronic acid ha filler is a softtissue filler that is used in 80% of the market. The demand for dermal fillers for facial softtissue augmentation procedures has increased due in part to the less invasive nature of these products compared with surgical procedures. Facial fillers can be helpful in minimizing these changes by restoring youthful fullness to periocular areas that have undergone volume loss or loss of support. Hyaluronic acid ha is a linear naturally occurring polysaccharide formed from repeating disaccharide units of nacetyldglucosamine and dglucuronate. Full text a 10point plan for avoiding hyaluronic acid.
Effect of injection techniques on the rate of local adverse events in patients implanted with nonanimal hyaluronic acid gel dermal fillers. However, this twodimensional technique is giving way to the threedimensional volume restoration that dermal fillers provide. Background hyaluronic acid ha fillers are becoming the material of choice for use in cosmetic soft tissue and. Among these fillers, ha fillers are the most popular because of their volumizing effect, biocompatibility, and easy correction after treatment. In this article, the use of hyaluronic acid ha dermal fillers for facial rejuvenation and volume restoration is discussed in depth. Abstractover the last 20 years, developments in injectable dermal fillers have led to a revolution in facial softtissue augmentation. Muhn and nathan rosen and nowell j solish and vince bertucci and mark lupin and alain dansereau and fred weksberg and b kent. Jul 14, 2017 dr tatiana lapa and mr rishi mandavia outline the pharmacology, rheology and application of hyaluronic acid dermal fillers. Ha and describes how the physical properties of ha dermal fillers may influence clinical outcomes. Pdf the evolving role of hyaluronic acid fillers for facial. Medical science liaison at galdermanestle skin health. Hyaluronic acid ha is a linear naturally occurring polysaccharide formed from. Understanding how the biochemistry of the product affects patient outcomes is an important step in setting and managing proper patient expectations.
Mar 20, 2020 however, the volumising effect and durability of pn dermal fillers are not as good as those of existing dermal fillers 15,20,21. Tridimensional midface rejuvenation using hyaluronic acid. Combining ha dermal fillers with other techniques allows an individualized treatment. These differences have the potential to affect the ability of the physician to provide the patient with a natural and enduring result. Durability of three different types of hyaluronic acid. It is the key ingredient in temporary dermal fillers and which also naturally occurs in the skin but depletes with age. Therefore, we report this interesting case of foreign body reaction after hyaluronic acid dermal filler injection. Key considerations for patient assessment and treatment planning are explored. Aging of the periocular area involves changes of the skin, muscle, fat, and bones. Hyaluronic acid ha is present among all living organisms and plays an integral part in the maintenance and regulation of moisture within tissues, due to its high affinity for water. Key concepts and properties relevant to the production and performance of ha dermal fillers, such as the degree of crosslinking, gel hardness, gel consistency, viscosity, extrusion force, ha concentration, and extent of hydration are explained. Three case studies of midfacial volume loss corrected with ha dermal fillers are described, with images to illustrate treatment. Soft tissue augmentation is an important tool in presentday cosmetic treatment. Key concepts and properties relevant to the production and performance of ha dermal fillers.
The science and art of hyaluronic acid dermal filler use in. Previous reported cases of foreign body reaction induced by hyaluronic acid dermal filler typically manifested as nodular lesions, but cellulitislike cutaneous manifestation has not been reported. The science and art of hyaluronic acid dermal filler use. Summary background the number of dermal fillers has expanded dramatically. Most of the complications associated with hyaluronic acid filler use are mild, transient and reversible. Oct 19, 2016 hyaluronic acid is a chemical compound which has revolutionised aesthetic medicine. By dr tim pearce, mbchb bsc hons mrcgp dermal fillers are products injected under the skin to replace or augment volume in a way that aims to improve the aesthetics of the face. A practical guide to dermal filler procedures is the second book in the new cosmetic procedures series especially designed for providers who would like to expand their practice to include minimally invasive cosmetic procedures. Over the last 15 years, hyaluronic acid ha fillers have become the most popular injectable biomaterial for soft tissue correction.
Hyaluronic acid fillers usually last 6 to 12 months and are popular for lip augmentation, which is a big plus. Dermal fillers course comprehensive injectable fillers. This class of dermal fillers is the mainstay of modern dermal filling practice around the world for the past 20 years. Compatibility of ha with the human body and reversibility of injected ha using intralesional hyaluronidase enzyme make ha based dermal fillers favorable for many injectors. Although all hyaluronic acid dermal fillers are based on the same ha molecule, a number of physical and chemical properties of ha can be altered by manufacturers to influence their products performance and outcomes. Hyaluronic acid fillers have become popular soft tissue filler augmentation agents over the past several years. Hyaluronic acid ha fillers have been on the market for many years. They are habased dermal fillers intended for the use as volumetric. Complications of hyaluronic acid fillers and their. Alternating units of 1,4 linked nacelylglucosamine and glucuronic acid. Hyaluronic acid works by acting as a cushion and lubricant in the joints and other tissues. Since the us food and drug administration approved restylane q med company, sweden in 2003, ha fillers made of crosslinked ha have been commonly used because of their superior safety compared to other pmma, paag, pcl, and plla fillers. They have helped revolutionize the filler market with a number of new products available for use for our patients.
In the other chapters of this volume, authors are describing injection techniques and general handling of hyaluronic acid gels. A comprehensive nonsurgical approach should therefore incorporate combining fillers such as highviscosity, lowmolecularweight hyaluronic acid lmwha for structural support and hyaluronic acid ha for lines, grooves and furrows with neuromodulators, lasers and energy devices. Safety and efficacy for the treatment of wrinkles, aging skin, body sculpturing and medical conditions. In addition, it might affect the way the body responds to injury.
Background hyaluronic acid ha fillers are becoming the material of choice for use in cosmetic soft tissue and dermal correction. Key rheological properties of hyaluronic acid fillers. Hapn hyaluronic acid polynucleotide, a new composite filler, has excellent biocompatibility and. Request pdf the science of hyaluronic acid dermal fillers background. Understanding the biochemistry of dermal fillers practical. Use of hyaluronic acid fillers for the treatment of the aging.
The beginning of the 21st century ushered in the introduction of newer nonbovine collagen fillers, cosmoderm and cosmoplast, and ha fillers, such as captique and juvederm, as. Safety and efficacy for the treatment of wrinkles, aging skin, body sculpturing and medical conditions article pdf available april 2011 with 1,202 reads. The use of injectable materials for softtissue augmentation has been increasing in the. The science of hyaluronic acid dermal filler skinviva training. Periocular fillers and related anatomy mdedge dermatology. Monheit, md,yz liping yu,phd, grace chang, and julia gershkovich background hyaluronic acid ha fillers are becoming the material of choice for use in cosmetic soft tissue and dermal correction. Hyaluronic acid filler and hyaluronidase springerlink. The science of hyaluronic acid dermal fillers request pdf. However, the volumising effect and durability of pn dermal fillers are not as good as those of existing dermal fillers 15,20,21. In 2015, hyaluronic acid ha dermal fillers accounted for more than 92% of all filler treatments in the us. A case of cellulitislike foreign body reaction after. Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement.